Medical Billing Specialist

Position Summary

The MedicalBilling Specialist is responsible for the accurate and timely billing, claimsubmission, payment posting, and follow-up of medical claims for Health CarePartners of South Carolina. This position ensures claims are processed inaccordance with payer guidelines while supporting the organization's revenuecycle goals. The Medical Billing Specialist works collaboratively withproviders, clinical staff, insurance carriers, and patients to resolve billingissues, maximize reimbursement, and maintain compliance with federal, state,HRSA, FQHC, and organizational requirements.
Essential Duties andResponsibilities
• Prepare, review, and submit accurate medicalclaims using appropriate CPT, HCPCS, and ICD-10 coding.
• Process billing for Medicare, Medicaid,commercial insurance carriers, and self-pay patients.
• Monitor claim status and follow up on unpaid,denied, or rejected claims in a timely manner.
• Correct and resubmit claims as necessary toensure prompt reimbursement.
• Post insurance and patient payments,adjustments, and reconcile billing transactions.
• Communicate with insurance companies regardingclaim status, reimbursement, and authorization issues.
• Respond to patient billing inquiries and assistwith payment arrangements when appropriate.
• Collaborate with providers and clinical staff toresolve documentation and coding issues affecting reimbursement.
• Maintain accurate billing records and patientaccount information within the Electronic Health Record (EHR) and practicemanagement system.
• Assist with accounts receivable follow-up andsupport departmental revenue cycle goals.
• Ensure compliance with HIPAA, HRSA, FQHCrequirements, payer guidelines, and organizational policies.
• Participate in staff meetings, requiredtrainings, and quality improvement initiatives.
• Perform other duties as assigned.
Education & Experience
• High school diploma or equivalent required.
• Minimum of two (2) years of medical billingexperience required.
• Experience in a primary care, family medicine,or multispecialty healthcare setting preferred.
• Experience working in a Federally QualifiedHealth Center (FQHC) or community health center preferred.
• Knowledge of Medicare, Medicaid, commercialinsurance, and payer reimbursement guidelines required.
• Experience using Electronic Health Record (EHR)and practice management systems preferred.
• Certified Professional Biller (CPB), CertifiedProfessional Coder (CPC), or equivalent certification preferred.
• Bilingual (English/Spanish) preferred but notrequired.
Knowledge, Skills, and Abilities
• Knowledge of medical billing, insurance claimsprocessing, accounts receivable, and payer reimbursement methodologies.
• Strong understanding of CPT, HCPCS, ICD-10, andmedical billing regulations.
• Excellent organizational, analytical, andproblem-solving skills with strong attention to detail.
• Strong customer service and communicationskills.
• Proficiency in Microsoft Office, ElectronicHealth Record (EHR), and practice management systems.
• Ability to maintain confidentiality and protectpatient information in accordance with HIPAA and organizational policies.